Insurance

The Centers for Medicare & Medicaid Services announced Friday that it is seeking a second round of applicants to the Pioneer ACO Model. It is also soliciting suggestions for new accountable care organization models that encourage greater provider integration and financial accountability.

Cancer drug prices have doubled in the past decade, from an average of $5,000 per month to more than $10,000.

This study shows that generic initiation improves adherence to antidepressant therapy among Medicare patients and mitigates the negative effects of the Part D coverage gap.

During the first eight months of this year, fewer than 18 percent of Medicare patients ended up back in the hospital within a month of discharge, the lowest rate in years, the government reported Friday.

Moving healthcare reimbursement from fee-for-service to a system that rewards quality care is easier said than done, but tools are emerging to help the cause. Three expert commentators featured in the inaugural issue of The American Journal of Accountable Care examined the challenges providers face, as they are being ask to share risk under new contracts with accountable care organizations, or ACOs.

Since 1992 Medicare has reimbursed physicians on a fee-for-service basis. In 1997, as medical costs escalated, Congress began using a Sustainable Growth Rate (SGR) formula to reduce reimbursements if overall physician spending exceeded the growth in the economy.

Access is an important component of the Triple Aim (cost, quality, access), and it has also been stressed as a significant factor in health reform initiatives. As the influx of uninsured increasingly seeks care, and if the number of providers available to provide primary care decreases as projected, achieving access to quality and cost-effective care may become more problematic.

The House of Representatives passed a 3-month patch late Thursday to stabilize physicians' Medicare payments -- delaying dramatic cuts scheduled for 2014 -- while Congress works on a permanent repeal of Medicare's sustainable growth rate (SGR) payment formula.

The Centers for Medicare & Medicaid Services (CMS) recently announced that Stage 2 of the EHR Meaningful Use program would be extended through 2016, especially as many healthcare CIOs continue to struggle with health IT tool vendors. This also means that Stage 3 will be delayed until 2017.

The bipartisan budget deal reached this week could drag out efforts to overhaul Medicare's payment formula for physicians as lawmakers pursue a short-term fix and attempt to extend and make other tweaks to Medicare provisions, including significant changes to reimbursement for long-term acute care.

Congress' work to reshape physician payments under Medicare and repeal the sustainable growth rate (SGR) payment formula took several pivotal steps this week.

Thousands of hospitals, large and small, are girding for cuts to their Medicare payments in 2014, as federal pay-for-performance programs aimed at boosting clinical quality, improving patient experience and preventing unnecessary hospital readmissions roll into their second year.

The downward trend in preventable hospital readmissions that began in 2012 has continued well into this year, according to data published Friday on the CMS' blog. Quality experts were impressed but had questions.

A bicameral effort is quickly gaining traction in an effort that would forever change the sustainable growth rate (SGR) and Medicare reimbursement model.

Medicare has agreed to allow specialist medical societies to determine the quality measures physicians will report when the new reporting system goes into effect on Jan. 1.

By all accounts, the shopping experience on HealthCare.gov has improved significantly. That means customers can routinely access information about what health plans and subsidies are available and select the product of their choice.

As the CMS begins the second year of a penalty program for preventable hospital readmissions required by the healthcare reform law, new research indicates that hospitals fare better when they focus on patient care more generally rather than targeting specific conditions, such heart failure, or specific timeframes, such as 30 days post-discharge.

Dr. Farzad Mostashari, former National Coordinator of Health IT, serves as guest editor of a special issue of AJMC, which covers the breadth of issues concerning how technology is affecting healthcare delivery, quality of care, and payment reform.

In what is likely to be a relief to dialysis providers, the CMS decided to phase in the controversial payment cut to dialysis providers over a three- to four-year period.

Electronic health records are changing the way your family doctor does business, with most now able to view lab results or send a prescription online, a change that advocates say will improve efficiency and lead to fewer medical errors.

New case management model achieves success in reducing readmissions and is easily duplicated across the Baptist Health System, Inc.

The administration was warned last spring that its website didn't meet key requirements for a successful rollout, including relying too heavily on outside contractors, according to a copy of a Red Team report.

More than 200 participants gathered in Baltimore for "Patient-Centered Oncology: Real-World Perspectives," which covered genetic testing, how to engage patients in decision-making, and how the "culture of medicine" continues to drive up costs despite calls to abandon the fee-for-service payment model.

Medicare payment reforms require valid measures of high-quality healthcare. Different types of administrative wait time measures predicted glycated hemoglobin levels for new and returning patients.

Finding a health plan on the Medicare website could be troublesome for some seniors.

More hospitals are receiving penalties than bonuses in the second year of Medicare's quality incentive program, and the average penalty is steeper than it was last year, government records show.

Researchers who want to study population health using the vast stores of Medicare and Medicaid data will no longer have to order it and wait for the federal government to ship them encrypted data files.

CMS Administrator Touted HealthCare.gov on Eve of Troubled Rollout

The American Journal of Managed Care recently sat with Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), as she discussed CMS's role in the new, evolving healthcare landscape. This special AJMCtv interview highlights just some of the initiatives CMS has implemented, as well as some of the challenges that remain for the organization.